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Clinical Utility of ¹⁸F-FDG PET/CT in Assessing the Neck After Concurrent Chemoradiotherapy for Locoregional Advanced Head and Neck Cancer

¹ Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York; ² Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York; ³ Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York; ⁴ Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York; and ⁵ Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York

View larger version (9K): [in this window] [in a new window]   FIGURE 1.  Flow chart shows distribution of findings in 84 heminecks studied. ND = neck dissection; f/u = follow-up.

View larger version (66K): [in this window] [in a new window]   FIGURE 2.  Transaxial PET (A) and CT (B) images of 69-y-old man 14 wk after definitive therapy. (A) Focus of increased 18F-FDG uptake (arrow) in left hemineck and no focal abnormal uptake in right hemineck. (B) Enlarged residual nodes in left (arrow) and right hemineck. Pathology revealed squamous cell tumor in left hemineck but no residual tumor in right hemineck. Thus, PET scan was TP in left hemineck and TN in right hemineck.

View larger version (75K): [in this window] [in a new window]   FIGURE 3.  Transaxial PET (A) and CT (B) images of 40-y-old man at 13 wk after definitive therapy. (A) Focus of increased 18F-FDG uptake (arrow) in left hemineck. (B) Corresponding enlarged residual node (arrow). Pathology revealed giant cell reaction but no viable tumor. Thus, PET was FP.

View larger version (67K): [in this window] [in a new window]   FIGURE 4.  Transaxial PET (A) and CT (B) images of 46-y-old man at 9 wk after definitive therapy. (A) No definite focus of increased 18F-FDG uptake in neck. (B) Enlarged residual node is seen in right hemineck on CT (arrow). Pathology revealed metastatic squamous cell carcinoma. Thus, PET was FN.

View larger version (15K): [in this window] [in a new window]   FIGURE 5.  Our suggested algorithm for use of combined PET/CT in evaluation of patients with HNSCC after definitive chemoradiotherapy. *Either as single PET/CT with full diagnostic CT with intravenous contrast or PET/CT with low-dose CT supplemented by a separate diagnostic CT or MRI with intravenous contrast. **Observation should be considered only after informed discussion with the patient and when close monitoring is guaranteed either as part of institutional practice or in a clinical study. LN = lymph node; ND = neck dissection; ECE = extracapsular extension; CRT = chemoradiotherapy.